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CLINICAL RESEARCH: CARDIAC IMAGING

Quantitative relation between hemodynamic changes during intravenous adenosine infusion and the magnitude of coronary hyperemia

Implications for myocardial perfusion imaging

Rakesh K. Mishra, MD, FACC^*, Sharmila Dorbala, MD, FACC^*, Giridhar Logsetty, MD^*, Alita Hassan, MPH, Therese Heinonen, PhD, Heinrich R. Schelbert, MD, FACC, Marcelo F. Di Carli, MD, FACC^*,* RAMPART Investigators

^* Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
Pfizer Global Research and Development, Ann Arbor, Michigan
Montreal Heart Institute, Montreal, Canada
UCLA School of Medicine, Los Angeles, California

Manuscript received July 6, 2004; revised manuscript received October 20, 2004, accepted October 26, 2004.

^* Reprint requests and correspondence: Dr. Marcelo F. Di Carli, Division of Nuclear Medicine, Brigham and Women's Hospital, Boston, Massachusetts (Email: mdicarli{at}partners.org).

OBJECTIVES: The goal of this study was to determine the relationship between changes in cardiac hemodynamics during intravenous adenosine (ADO) infusion, and myocardial blood flow (MBF).

BACKGROUND: The relationship between changes in MBF and the peripheral hemodynamic effects during peak adenosine infusion is unknown.

METHODS: We studied 348 (age 57 ± 11 years; 106 females) without evidence of obstructive coronary artery disease by positron emission tomography (PET). Patients underwent [¹³N]ammonia PET imaging to measure MBF and coronary vascular resistance (CVR) at rest and during a standard 6-min ADO infusion. Changes in heart rate (HR) and mean arterial pressure (MAP) were measured at baseline and during peak hyperemia.

RESULTS: During ADO, HR increased (delta: 24 ± 11 beats/min) and MAP decreased (delta: –2 ± 10 mm Hg). Overall, delta HR correlated poorly with hyperemic MBF (R = 0.10, p = 0.06) and with CVR (R = 0.11, p = 0.04). Delta MAP also showed a weak correlation with hyperemic MBF (R = 0.04, p = 0.44) and with CVR (R = 0.11, p = 0.04). Patients in the lowest tertile for delta HR showed a 7% lower hyperemic MBF (1.84 ± 0.6 ml/min/g vs. 1.98 ± 0.6 ml/min/g, p = 0.022) and an 8% higher CVR (54 ± 20 mm Hg/ml/min/g vs. 50 ± 17 mm Hg/ml/min/g, p = 0.056) compared with those in the highest tertile. Patients in the lowest tertile for delta MAP (i.e., greatest decline) showed similar hyperemic MBF, and an 8% lower CVR compared with those in the highest tertile (p = NS for both). These small differences between tertiles remain, even after adjusting for differences in age, gender, smoking status, and lipid profile.

CONCLUSIONS: Changes in cardiac hemodynamics during intravenous ADO are generally poor predictors of changes in MBF and CVR during peak hyperemia, and, thus, they should not be used to assess the effectiveness of vasodilator stress in myocardial perfusion imaging.

Abbreviations and Acronyms   CAD = coronary artery disease   CFR = coronary flow reserve   CVR = coronary vascular resistance   HR = heart rate   MAP = mean arterial pressure   MBF = myocardial blood flow   MPI = myocardial perfusion imaging   PET = positron emission tomography

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